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Thread : Is this ethical?  
29 Sep 2010 @ 3:47 PM
LadyADD Join Date: Tue 28th Sep 2010
Threads: 1 Posts: 1
Is this ethical?

I've been on stimulant meds for over 10 years, and have tried alternative treatments with no success. This past year i was asked to sign a contract at my doctors office basically stating that I wouldn't abuse the presribed drugs. No big deal, as that was the last thing on my mind. By the way I am /was on 54 mg of concerta. Now I have a new doctor , not by choice. That is a complete jerk. He told me that ADD goes away, and that we need to work on getting me off the concerta. Before I left his office he had me sign his own contract, and submit to a drug test. I recieved a letter in the mail today saying that my concerta levels were negative, and thus my doctor could no longer prescribe me concerta.!? I understand where he is coming from, and it's thanks to drug dealing pill poppers that I have to suffer. HOWEVER is it fair for him to assume that this is what I am doing with my pills? I actually had been off of my concerta for about 5 days, not sure if this would impact it. My doctor stated that if I had any questions to call his office, but based on his attitude towards my ADD in the first place I am unsure if I would like to continue treatment with him. At the same time has his little lab test tainted my record, if I switch doctors will I be looked at as a patient who just wants to TREAT her ADD or as a druggie that is doctor shopping? Grrr just very frusterated with this issue. So maybe there is no middle ground here and my doctor can legally discontinue concerta treatment, however isn't he ethically responsible with providing me alternative treatments/medications or at least access to such.

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30 Sep 2010 @ 4:10 PM Reply # 1
eabeam Join Date: Tue 12th Jan 2010
Threads: 0 Posts: 97
Time to get a new doc...

There is a lot in your post.

Ethical? Technically, yes. It is the medical doctor's call on what medications to, or not-to, prescribe.

However, saying that "ADHD goes away..." to me is a warning sign that this doc hasn't read up on the topic.

http://askdreric-schoolpsychologist.blogspot.com/

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30 Sep 2010 @ 8:35 PM Reply # 2
LadyADD Join Date: Tue 28th Sep 2010
Threads: 1 Posts: 1
a little more

So I go back to this doctor in a couple of weeks, and I am just curious as to how to approach him. With his skewed views on this disorder, doctors can be very intimadating. LOL I wil think of what I want to say to him about my disorder, and how I cannot concentrate without my meds, but I will end up saying nothing. Maybe I will just have to get over it and use my big voice , after all it's my health. I understand that it is his choice to medicate me or not. He did say that he would take care of all my medical needs except for that, because the test came back negative, I was curious though , if he is not going to provide me with treatment options- can I go elsewhere, without being sterotyped as being some doctor shopping patient? Thanks for all the help :)

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4 Oct 2010 @ 10:01 PM Reply # 3
Megansmom Join Date: Sun 28th Feb 2010
Threads: 0 Posts: 12
Just a thought....

I would think any doctor that actually thinks like this (like your trying to "abuse drugs" by taking Concerta) isn't going to be a big help to you, anyway. It doesn't sound like you have a lot to lose by shopping around for one that's a little more open to this, or one that has some other idea for treatment. Is this a primary care physician that your talking about? I don't think they are all able to diagnose & treat AD/HD anyway, even in children! ?They are able to write the prescription, but most pediatricians have told me they don't really know much about it. You may want to work on finding a mental health professional and taking it out of the doctor's hands altogether. If this is a mental health professional, again, it doesn't sound like you have much to lose by finding another one. I think changing his mind is going to be more trouble than it's worth, if it can be done at all. A doctor that's open to this diagnosis is probably going to believe you when you tell them what really happened, and any that don't aren't going to be helpful anyway. I would think if anyone was going to abuse prescription drugs, Concerta wouldn't exactly be their first choice (what I read up about it makes it pretty useless to try to use that way, anyway). This doctor's whole premise just doesn't sit right.

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7 Oct 2010 @ 5:57 PM Reply # 4
eabeam Join Date: Tue 12th Jan 2010
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Less Concerned about the abuse suspicion...

I am actually less concerned about the abuse suspicion. The reality is... a ton of people do abuse prescription meds and also sell prescription meds. We actually need more professional diligence on that issue. That is a separate issue. I don't want to make any judgments against the poster nor the doctor in that regard. Individual facts are too critical to make any easy judgment on what the doctor is seeing and why...

The red-flag to me is saying that people outgrow ADHD.

Either way, the best answer is to ask deep, insightful questions. Why does the doc feel that your prescription is problematic? Can it be explained in plain English without hiding behind credentials or jargon? Reasonable answers could be... "The research shows a higher likelihood of addiction over the threshold of ???mg. Therefore, it seems that the risk-to-benefit ratio is bad. Maybe we should try a different medication to see if we can get a better benefit with less potential negative side-effects. If it does not work, maybe the time-away will help reduce your tolerance to the methyphenidate."

If the doc says something that is off-base, like adults outgrow ADHD.... you can say, "Gee, I have done some research (Hallowell or Barkley, for example) and the stuff that I read contradicts that statement, can you cite some research for me to follow-up on?"

If the answer is an attitude instead of a reasonable answer, that is a sign that you called out the doc's B.S.

http://askdreric-schoolpsychologist.blogspot.com/

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13 Oct 2010 @ 7:42 PM Reply # 5
Megansmom Join Date: Sun 28th Feb 2010
Threads: 0 Posts: 12
Interesting FYI regarding Concerta's "abuse" potential.

Here's what I found (easily) when I googled "concerta abuse" (This is what my 12 year old daughter takes, same dosage of 54 mg, too):

"Concerta is really hard to abuse. Your much better off just getting something else." it's from some forum:

http://www.hipforums.com/newforums/archive/index.php/t-104918.html

They go on to say:

"YOu didn't pay for it did you?? Concerta as far as getting high is concerned, is basically worthless. The middle is a gel that you can't really snort and the capsule runs straight through your system. I would try adderall- just the amphetamine salts. They are cheaper than namebrand adderall if you get a prescription, and they aren't time released."

Straight from some junkie's mouth. I'm relieved! This site could be an AD for Concerta as far as I'm concerned!

I don't know what that site really is, but it's obviously for people who have actual experience in abusing Rx's!!!. I'm thinking, they should know. Whatever they like, I don't want, whatever they don't like, let's try that!

I also think the "you outgrow AD/HD" statement is a dead giveaway of a doctor that doesn't understand this, too. I just wanted to give you some extra ammunition regarding the whole abuse angle that's particular to this medication. The whole difference (and only really key difference, from what I understand) between Concerta and regular old Ridalin IS the time-release thingy that makes Concerta pretty much not worth abusing. As for the existence of adult AD/HD, and the tendency of WOMEN IN PARTICULAR to not be properly diagnosed? There's a ton of research out there, these days. You could go to your local public library, try a catalog search for both subjects (AD/HD in adults & women) and bring in a STACK of books for your doctor. I'd bet $50 the same doctor tries to tell you that your really depressed (AD/HD in women is mistaken for depression, well, most of the time). I think Welbutrin (an anti-depression medication) works for AD/HD, too (for some people). That would be ironic (your doctor taking you off a medication that has pretty much, no real abuse potential, one that drug addicts warn each other not to bother with, for one that you could sell on the street-if you were so inclined!) Real genius, this guy! I just thought that was tooooo funny not to share:)

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15 Oct 2010 @ 11:47 AM Reply # 6
eabeam Join Date: Tue 12th Jan 2010
Threads: 0 Posts: 97
Concerta is still abused.

That post is relative to what else is readily available. I know "patients" of this guy... http://articles.latimes.com/2010/apr/14/local/la-me-doctor-arrest14-2010apr14

The reality is, Concerta is still methylphenidate. I don't know what is popular now, but this is still the same active ingredient as Ritalin (methylphenidate). At 54 mg a day, this is 5400 mg with a 100 day Rx.

When I was in college in the 1990's, the druggies offered me $3 a pill for 5mg Ritalin and $6 for a 20mg. I never took them up on it, but with a $20 co-pay, I could have sold $500 worth of pills for them to crush and snort. That is not small change for a poor college student. Well, until I dropped out, because I would not have remained a college student without my prescription.

The reality is, prescription drug abuse is a huge problem that does not get enough press. http://www.nlm.nih.gov/medlineplus/prescriptiondrugabuse.html

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19 Oct 2010 @ 11:09 PM Reply # 7
Megansmom Join Date: Sun 28th Feb 2010
Threads: 0 Posts: 12
I'm not disagreeing with that, either.

I'm not saying Concerta can't be abused, just that, if abuse is what someone is after, there are obviously easier choices. Prescription abuse IS huge, and it's way too easy to find a doctor that just wants to write a prescription and get you out of his office. I just don't think I've heard of anyone purposefully going after this particular brand for those purposes. Ridalin or Adderall would seem to be a more obvious choice. From what I understand, it's hard enough for adults, and I'm sorry --but especially for women, to get anyone to take an AD/HD diagnosis seriously, much less to find something that helps, then be suddenly cutoff from it and accused of abuse. Don't stimulants leave your system pretty quickly anyway? Didn't this doctor test for the Concerta after you didn't have it for an entire week? Seems like some really shaky reasoning. While I know that any of these prescriptions have at least some abuse potential, I'd still think it would work a little more like car theft----having the club on your steering wheel doesn't really stop someone who WANTS to steal your car, it just makes the car thief want to go for an easier choice-if there's a car with no anti-theft device available. Having a prescription that is a total hassle to crush and snort (or whatever it is they do) makes it less likely to attract people who want to abuse it. If someone just feels the need to abuse something, and if Concerta is the only thing available to them, I'm sure there is a way. Even cough medicine can be abused. I still want cough medicine if I'm sick and can't stop coughing. I shouldn't have to suffer because someone else is stupid enough to abuse cough medicine, and adults with AD/HD that are diligent and responsible enough to seek adequate treatment shouldn't have to suffer over misinformation. If there's a real reason to suspect abuse, such as, calling the doctor because the prescriptions's been "lost" (several times) or the pills were "destroyed" (more than once) etc., then I can understand. I seriously doubt anybody's making a living by getting Concerta prescriptions, and selling them on the street. Oxycontin, certainly. Maybe even Adderall. Concerta is just , well, not as likely to be profitable, in comparison to what's out there. It would be an odd choice, that's all.

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